75H71424D00001.pdf

75H71424R00001

SOLICITATION, OFFER AND AWARD

4. TYPE OF SOLICITATION2. CONTRACT NUMBER 3. SOLICITATION NUMBER

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

ORDER UNDER DPAS (15 CFR 700)

6. REQUISITION/PURCHASE NUMBER

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

NEGOTIATED (RFP)

SEALED BID (IFB)

5. DATE ISSUED

1. THIS CONTRACT IS A RATED RATING PAGE OF PAGES

1 68

C. E-MAIL ADDRESS

EXT.NUMBERAREA CODE

B. TELEPHONE (NO COLLECT CALLS)A. NAME

10. FOR

INFORMATION

CALL:

CAUTION: LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

(Date)(Hour) local timeuntildepository located in copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the

SOLICITATION

9. Sealed offers in original and

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND

LIST OF ATTACHMENTS

CONTRACT CLAUSES

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

I

J

K

L

M SPECIAL CONTRACT REQUIREMENTS

CONTRACT ADMINISTRATION DATA

DELIVERIES OR PERFORMANCE

INSPECTION AND ACCEPTANCE

PACKAGING AND MARKING

DESCRIPTION/SPECS./WORK STATEMENT

SUPPLIES OR SERVICES AND PRICES/COSTS

SOLICITATION/CONTRACT FORM

PART II - CONTRACT CLAUSESPART I - THE SCHEDULE

H

G

F

E

D

C

B

A

SEC. DESCRIPTION PAGE(S) (X) DESCRIPTION SEC. (X)

11. TABLE OF CONTENTS

18. OFFER DATE17. SIGNATURE

SUCH ADDRESS IN SCHEDULE.

IS DIFFERENT FROM ABOVE - ENTER

15C. CHECK IF REMITTANCE ADDRESS

EXT.NUMBERAREA CODE

15B. TELEPHONE NUMBER

(Type or print)AND

ADDRESS

OF

OFFEROR

CODE FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER15A. NAME

DATEAMENDMENT NO.DATEAMENDMENT NO.

and related documents numbered and dated):

amendments to the SOLICITATION for offerors

(The offeror acknowledges receipt of

14. ACKNOWLEDGEMENT OF AMENDMENTS

CALENDAR DAYS (%)30 CALENDAR DAYS (%)20 CALENDAR DAYS (%)10 CALENDAR DAYS (%)

(See Section I, Clause No. 52.232.8)

13. DISCOUNT FOR PROMPT PAYMENT

designated point(s), within the time specified in the schedule.

by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

OFFER (Must be fully completed by offeror)

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

28. AWARD DATE

(Signature of Contracting Officer)

27. UNITED STATES OF AMERICA

25. PAYMENT WILL BE MADE BY

26. NAME OF CONTRACTING OFFICER (Type or print)

CODE 24. ADMINISTERED BY (If other than Item 7)

ITEM

(4 copies unless otherwise specified)

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

41 U.S.C. 253 (c) ( 10 U.S.C. 2304 (c) (

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

21. ACCOUNTING AND APPROPRIATION20. AMOUNT19. ACCEPTED AS TO ITEMS NUMBERED

AWARD (To be completed by government)

CODE

11/01/2023 X

75H71424D00001

Tucson Area Office 7900 S. J Stock Road Tucson AZ 85746

MICHAEL THORNE 520

Michael.Thorne@ihs.gov

295-2445

X

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PAGE(S)

HHS NET 30P

127957

AMERICAN INDIAN ASSOCIATION OF TUCSON 127957

Attn: JACOB

AMERICAN INDIAN ASSOCIATION OF TUCS

160 N STONE AVE

TUCSON AZ 85701

See schedule

X

IHSALBUQUERQUE

See Schedule GSee Schedule G

SUSAN M. PROTHO

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

Prescribed by GSA - FAR (48 CFR) 53.214(c)

) )1

$0.00

1-3

5-27

30-34 35-43 44-48

49-58

60-63

64-67

1/1/2024 12:00:00AM

12. In compliance with the above, the undersigned agrees, if this offer is accepted within _____60_________ calendar days (60 calendar days unless a different period is inserted

75H71424R00001-0001 10/26/2023

520 884-7131 2212 12/21/23

Jacob Bernal/Executive Director

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 68

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

AMERICAN INDIAN ASSOCIATION OF TUCSON 127957

75H71424D00001

(A) (B) (C) (D) (E) (F)

UEI: STFBPJ6FLRN3

The Contractor shall provide Referral and Limited

Ambulatory Service for the eligible Urban Indian population of Tucson, Arizona.

Admin Office:

Tucson Area Office

7900 S. J Stock Road

Tucson AZ 85746

Payment:

IHSALBUQUERQUE

4101 Indian School Rd NE, Suite 225

Albuquerque NM 87110

Period of Performance: 01/01/2024 to 09/30/2024

1 Base Year: FY 2024 Title V Urban funding. 1,375,155.00

Obligated Amount: $0.00

Delivery Location Code: IHSTUCSONCENTER

IHSTUCSONCENTER

160 N. STONE AVE

TUCSON AZ 85701 US

Amount: $0.00

2 Option Year One: FY 2025 Title V Urban funding. 1,575,155.00

Amount: $1,575,155.00(Option Line Item)

10/01/2024

Delivery: 10/01/2024

Delivery Location Code: IHSTUCSONCENTER

IHSTUCSONCENTER

160 N. STONE AVE

TUCSON AZ 85701 US

Amount: $0.00

3 Option Year Two: FY 2026 Title V Urban funding. 1,575,155.00

Amount: $1,575,155.00(Option Line Item)

10/01/2025

Delivery Location Code: IHSTUCSONCENTER

IHSTUCSONCENTER

160 N. STONE AVE.

TUCSON AZ 85701 US

Amount: $0.00

4 Option Year Three: FY 2027 Title V Urban funding. 1,575,155.00

Amount: $1,575,155.00(Option Line Item)

10/01/2026

Delivery Location Code: IHSTUCSONCENTER

IHSTUCSONCENTER

Continued ...

OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

NSN 7540-01-152-8067

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 68

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

AMERICAN INDIAN ASSOCIATION OF TUCSON 127957

75H71424D00001

(A) (B) (C) (D) (E) (F)

160 N. STONE AVE.

TUCSON AZ 85701 US

Amount: $0.00

5 Option Year Four: FY 2028 Title V Urban funding. 1,575,155.00

Amount: $1,575,155.00(Option Line Item)

10/01/2027

Delivery Location Code: IHSTUCSONCENTER

IHSTUCSONCENTER

160 N. STONE AVE.

TUCSON AZ 85701 US

Amount: $0.00

The total amount of award: $7,675,775.00. The obligation for this award is shown in box 20.

OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

NSN 7540-01-152-8067